5160-15-01
Transportation: definitions.

(A)
This chapter sets forth the transportation services
that are available as benefits under the medicaid state plan. Provisions in
this chapter do not apply to transportation services for which a per diem
payment is made to a long-term care facility (LTCF) in accordance with Chapter
5160-3 of the Administrative Code.

(1)
"Advanced life support, level 1 (ALS1)" is transport by
ground ambulance and the provision of medically necessary supplies and services
at a level beyond the scope of an EMT-basic but within the scope of an
EMT-intermediate or EMT-paramedic specified in Chapter 4765. of the Revised
Code.

(2)
"Advanced life support, level 2 (ALS2)" is ALS1 during
which at least one of the following procedures is performed:

(a)
At least three
separate administrations of one or more medications (except crystalloid fluids)
by intravenous means or by continuous infusion;

(a)
"Air ambulance" is an aircraft that meets the
definition of "fixed wing air ambulance" or "rotorcraft air ambulance" set
forth in section 4766.01 of the Revised Code and
meets the standards and license requirements specified in Chapter 4766. of the
Revised Code.

(i)
"Fixed-wing air ambulance" has the same meaning as
"fixed wing air ambulance."

(ii)
"Rotary-wing air
ambulance" has the same meaning as "rotorcraft air ambulance."

(b)
"Ground ambulance" is a vehicle that meets the definition of
"ambulance" set forth in section
4766.01 of the Revised Code and
meets the standards and license requirements specified in Chapter 4766. of the
Revised Code.

(5)
"Attendant" is an individual employed by a
transportation provider, in addition to the minimum crew of a wheelchair van or
a ground ambulance, who aids in the non-emergency transportation of
medicaid-eligible individuals who require extra assistance.

(6)
"Basic life
support (BLS)" is transport by ground ambulance and the provision of medically
necessary supplies and services at a level within the scope of an EMT-basic
specified in Chapter 4765. of the Revised Code.

(7)
"County
department of job and family services (CDJFS)" is an entity established under
section 329.01 of the Revised Code or a
group of such entities acting together under a formal collaborative
agreement.

(8)
"Documentation" is information recorded in an
appropriate medium for the purpose of substantiating an assertion. Information
that is not relevant to a situation or does not support a statement about a
situation is not documentation.

(9)
"Eligible
provider" has the same meaning as in Chapter 5160-1 of the Administrative
Code.

(10)
"Emergency" is a situation that requires immediate
response for the provision of medical treatment, particularly a situation in
which the sudden onset of a medical condition manifests itself in acute
symptoms so severe that the absence of immediate medical attention could
reasonably be expected to result in serious harm to an individual's health,
significant impairment of a body function, or failure of a body organ or part.
An ambulance service may be considered to be of an emergency nature when an
individual, at the time of transport, requires health-related assistance
including but not limited to the following services:

(a)
Immediate medical
attention for a serious injury, an acute illness, or the sudden instability of
a physical condition;

(11)
"Emergency medical technician (EMT)" is an individual who
holds a current, valid certificate issued under Chapter 4765. of the Revised
Code at one of three levels: EMT-basic, EMT-intermediate, or
EMT-paramedic.

(12)
"Loaded mileage" is the distance traveled to or from a
medicaid-coverable service with a medicaid-eligible individual in the vehicle.
Air ambulance mileage is expressed in statute miles.

(13)
"Long-term care
facility" is either an intermediate care facility for individuals with
intellectual disabilities or a nursing facility, both of which are defined in
Chapter 5160-3 of the Administrative Code.

(14)
"Manual review"
is the examination of a claim by an employee of the department for the purpose
of determining whether it meets criteria for payment.

(15)
"Medicaid-eligible individual" is an individual who meets
eligibility requirements of the medicaid program.

(16)
"Medicaid-coverable service" is a service or procedure, exclusive of the
transportation services specified in this chapter, that either is itself
payable under the Ohio medicaid program in accordance with agency 5160 of the
Administrative Code or is intrinsically related to a payable service or
procedure (e.g., a follow-up visit within a defined period after
surgery).

(17)
"Mobility-related assistive device" (or "mobility
device") is a piece of equipment that is intended primarily to facilitate human
locomotion and cannot be classified as a motor vehicle, common carrier, or
similar conveyance. For purposes of this chapter, a mobility device is a manual
wheelchair, power wheelchair, power-operated vehicle (scooter), or wheelbench
(a device, similar in function to a wheelchair, that is used by a person in a
recumbent position).

(18)
"Non-emergency" is a situation that does not require
immediate response for the provision of medical treatment.

(19)
"Non-emergency
transportation" is transportation for an individual whose medical condition
does not require immediate response for the provision of medical
treatment.

(20)
"Personal assistant" is an individual who accompanies
and provides necessary assistance to a medicaid-eligible individual during
non-emergency transport that has been arranged through a county department of
job and family services.

(21)
"Point of transport" is the terminus of a trip, either
the place of origin or the destination.

(22)
"Signature" is a
distinctive mark (usually taking the form of a name) that is made in order to
indicate a person's responsibility for a document or other material. A
signature may be written in someone's own hand or produced in any other legally
valid manner.

(23)
"Specialty care transport (SCT)" is interfacility
transport of a critically injured or ill individual by ground ambulance and the
provision of medically necessary supplies and services at a level beyond the
scope of an EMT-paramedic that must be furnished by one or more health
professionals in an appropriate specialty area (e.g., emergency or critical
care nursing, emergency medicine, respiratory care, cardiovascular care) or by
an EMT-paramedic with additional training.

(24)
"Transportation
provider" is an eligible provider that furnishes wheelchair van or ambulance
services and meets the minimum requirements specified or referenced in this
chapter. For purposes of this chapter, a vendor under contract with a CDJFS to
transport medicaid-eligible individuals is not considered to be a
transportation provider.

(25)
"Wheelchair van" is a vehicle that meets the definition
of "ambulette" set forth in section
4766.01 of the Revised Code,
meets the standards and license requirements specified in Chapter 4766. of the
Revised Code, and meets standards specified in Chapter 4766-3 of the
Administrative Code.